Author: Dr. William Rassman

I have noticed that I’ve been losing my hair since I was about 18 years old. For the past few years , I’ve been using finasteride, nizoral, and minoxidil. It worked for a couple years but now I’m noticing that my hair has been falling at a very fast rate. I currently live in Seoul, South Korea, and I have been thinking about having a hair transplant but I’m afraid of having one at a young age.
Do you have any advice?

There are things you need to be clear of:
1) Losing hair is not fun but it may be something you may have to face. More than 50% of men face some degree of genetic hair loss. If you are worried, find a doctor who can give you a diagnosis and a Master Plan for how to possibly address the hair loss.
2) You don’t have to have a hair transplant. Losing hair does not automatically mean you need to have surgery. There may be other options such as medication or scalp micropigmentation.
3) As you live ins Seoul Korea, you can always visit my colleague Dr. Jino Kim of New Hair Institute in Seoul Korea.

I was wondering if you could give some more input on the new LLT study from the American Journal of Clinical Dermatology.

What do the results mean? How does it compare to other treatments like Minoxidil or Finasteride?

Would this be useful for someone like myself who is just starting to have miniaturized follicles and are the results of the study impressive at all?

Is it to early to tell or does this study point to LLT being beneficial?

I found a copy of the study online HERE.

If you read the conclusion (at the end) it states there was some statistical improvement after a 6 month study comparable to Rogaine or Propecia use. But in the long term (over a year) Rogaine and Propecia was better.

The conclusion also stated: “A higher percentage of lasercomb-treated subjects reported overall improvement of hair loss condition and thickness and fullness of hair in self-assessment, though the results did not always reach statistical significance.”

In my experience, the results that I have seen from patients who have used lasers were equivocal. I personally did not see gross improvement when I followed up with them. (Results were not dramatic) Maybe this is my bias, but I have on many occasions seen patients who had dramatic results with Rogaine or Propecia. I have not seen a “worth while” results with laser light therapy alone. Seeing a statistical improvement is not like seeing a cosmetic improvement.

How many hours does it take for each SMP sessions and how many sessions will it take? I understand it is permanent ink and was wondering if it fades after time and would need additional touchups? What happens when my hair turns gray? Will I need additional touch ups at that time? How many additional treatments after graying would be recommended?

Yes, there are between 2-4 procedures over a time span of a few weeks (you work that schedule with us). A full head SMP takes between 20-30 hours and we like to see some spacing between the procedures so that if it is going to fade, we can adjust for the fading on the subsequent session. The cost is $7,000 for an entire head SMP and we generally cover it until you are happy with the results. If it fades more than most people, we will do extra work at no charge. Touch-up may occur after a year or so at a cost of $500/tough-up. Most of our patients have not come back for touch-ups. We use a variation of gray/black or gray/brown in the inks and if you turn gray, worst case years down the road (and the inks did not fade enough for you) you might want to color your hair. You can expect that the pigment will fade over long periods of time. The absolutely best way to know the answer to your questions about graying over time, is to come to our Open House and we usually have a patient with gray hair so that you can see the answer for yourself. I hope that this answers your questions.

Bad Concealer (Too Much)

No Concealer , No SMP

With SMP

This patient was 87 year old with SMP who had Toppik plastered on his head and he looked ghoulish. We just washed the hair and then did an SMP on his whole head (see attachment). A different man who is now dating again. Age does not mattern.

I am a 33 year old woman who has been completely bald (by choice) about eight times. I have been shaving my head since 2008, and my hair is usually about a number 1. I did not do this to raise money for cancer research, or anything similar. I shave my head because I love having short hair. I think it is very sad that so many people consider hair loss to be a bad thing, and spend ludicrous amounts of money just to have more hair.

I shave my head myself every week and spend about 30 cents a week on shampoo. I own a few beanies for Winter, and in Summer I never have that disgusting feeling of sweat-soaked hair.

Why have hair, when you can just shave it all off? I used to have beautiful long hair, but it is more fun to NOT have hair.

If you are worried about hair loss, you must have a very boring life!

Thank you for sharing your experience. I think bald can be beautiful too! But hair loss does bother many men and women and at least they have a choice to do something or nothing about it!

Merck states that “Contact with the semen from a man being treated with PROPECIA is not a risk to the unborn child of a pregnant woman“. My question is: can the same rule be applied to those taking DUTASTERIDE, considering this is a higher potent DHT inhibitor? I take 0.5mg daily for the treatment of hair loss.

Probably not, but we don’t know. Dutasteride can also have fertility issues in the men who take this drug, but the proof is not available at this time. This is probably one of the many reasons that dutasteride is not approved for the treatment of hair loss by the FDA.

Can You Use Leg or Body Hair for Eyebrow Transplants? I understand that if you use head hair for eyebrow transplants, the hair will keep growing longer than the other hairs on the eyebrow and I don’t like cutting my eyebrows.

Leg hair has a different hair cycle than head hair. Some body hair has 70% of its life cycle in telogen (sleep) and does not appear on the recipient area transplanted therefore but 30% of the time. So a successful eyebrow transplant with body hair, will keep to its growth cycle. It will disappoint the recipient as only about 70% of the hair will grow at any one time, even if it was successfully transplanted. There is no way to stop head hair moved into the eyebrow from growing. I generally joke to my patients that they can grow a pony tail from an eyebrow transplant. So basically, you will have to cut these hairs twice a week or so, and when you cut them, they must be cut on an angle making the tip look sharp.

The Scientific American reported a fix for hair loss in August 1914. Let me share it with you. “A gold wire 1/500 inch in diameter is bent to form a loop barely visible to the naked eye, which is then threaded with a woman hair of the desired color and from 8 to 12 inches long. The wire is introduced into a Pravaz hypodermic needle and then bent and cut, forming a tiny hook. The needle is inserted normally, twisted and carefully withdrawn. The doubled hair is anchored by the hook in the subcutaneous tissue. As many as 50,000 hairs may be required. ”

Source: Scientific America

That amounts to 15 grains of gold. Someone made money out of this.

Hi Dr – Firstly just wanted to say thank you for the wonderful work you are doing on this site!

I took Propecia 1mg for 8 years, but a couple of years ago I noticed I was losing ground (NW1 – NW3). I increased my Propecia dosage to 2mg and have been taking this for the past 2 years and experienced no side effects.

I am 34 years old now and thinking of starting a family. My question is: Is it safe to be on 2mg Propecia a day and trying for a baby? If I completely stopped Propecia now, how long will it take for the drug to be completely out of my system? I really worry that, so much Finasteride will pose a risk to my unborn child? I will be discussing this with my doctor, but you are a specialist in this field and would really appreciate some advice.

First and foremost, please follow up with your doctor and address your question to him/her.

I have some issues with your history and you need to follow your doctors recommendation. If you are a Norwood 1 or even 3, I question if you should have been on Propecia. Propecia does not work to prevent a mature hairline from forming. Propecia is meant for the frontal area, the top and the crown areas. It is sometimes taken in hopes that it will help with the frontal corners but that decision is up to you and your doctor. At least you didn’t have any side effects and you seem to have done well. Another issue is that higher dose of Propecia doesn’t really work any better than the 1mg dose.

Finally, Propecia does not affect conceiving or having a baby. There is no evidence of this. For those who are still worried about it, Propecia has a half life of about 4 hours in the blood stream. This means almost all the medication will be out of your blood stream in 1 day. With respect to tissue fixation and possible traces left in your body it can take between 1 to 2 weeks. Considering the thousands of men who may have fathered children while on the drug, to my knowledge there has been no medical issues or legal issues.

Hi Dr’s Rassman and Pak, I came across this new hair loss cure. Have you seen this and do you think it is genuine?

http://www.significanceofhair.com/nz2OkLfSa/m/

If you read my blog, you know my answer is buyer beware. The website you point to is linked to a sales website. It is operated out of Panama and hosted in Amsterdam.

I highly doubt the article give the viewer a genuine interview. Dr. “A Chan” probably does not exist either. If she does, she probably didn’t give that interview. Thus the initials on the name to give plausible deniability. I’m sure they’ll make their quick buck and disappear into the sea of similar products or possibly re-branded the product under a different name once this sales cycle burns out. If I am wrong, then I would like to see the actual clinical study or have Dr. Chan give me a call and refer to me the “patent” who was the focus of the ‘cure’.

I just heard that people who use minoxidil lotion for hair loss, should stop taking aspirin. Is it true?

Drug.com reports “There were no interactions found in our database between Aspirin Low Strength and minoxidil. However, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.”. I could not find the reference that says these two drugs have an interaction.

If you want the biochemical reasoning, Aspirin works by inactivating an enzyme called cyclooxygenase (COX) which ultimately suppress the production of prostaglandins and thromboxanes. This is a good thing if you want to treat pain, decrease inflammation, decrease the risk of heart disease, etc. Aspirin is a great medication.

It isn’t quite clear on the exact mechanism of action but minoxidil but it is thought to work by stimulating one of the cyclooxygenase (COX) enzyme which increase the production of a certain prostaglandins type “E2″ (PGE2). There is some evidence that hair loss is thought to be related to the decrease in PGE2 so increasing PGE2 with Rogaine makes sense.

In the end, you need to speak to your doctor. If you are taking Aspirin for medical health reasons, it is far more important to continue taking Aspirin over an elective medication such as Rogaine.

Of note minoxidil is also available as an oral medication to decrease blood pressure. Many men and women from outside the US (third world) take it to lower their blood pressure. I am curious if there will be studies that show how Aspirin affects the efficacy of minoxidil.